During the COVID-19 pandemic focus has been on polyethylene glycol (PEG) and polysorbate as these excipients are constituents in the first vaccines and possible elicitors of allergic reactions to the vaccines. Before diagnosis, all 5 patients were mislabeled as allergic to multiple medications and their clinical management had become increasingly challenging. Clin Immunol. Stehlin F, Mahdi-Aljedani R, Canton L, Monzambani-Banderet V, Miauton A, Girard C, Kammermann K, Meylan S, Ribi C, Harr T, Yerly D, Muller YD. Four of the 5 cases developed anaphylaxis to medications con The easiest way to search for propylene glycol in a product is to read the ingredient list. Given our patient's extreme sensitivity to skin testing with PEG, investigation should be approached with caution. Clipboard, Search History, and several other advanced features are temporarily unavailable. HHS Vulnerability Disclosure, Help While it takes quite a bit of detective work and assertiveness, it is possible to live without glycols. Propylene glycol (PG) is a very interesting chemical. 7 Epub 2022 Mar 24. An official website of the United States government. Mrs. Smith had developed a particular type of food allergy called systemic contact dermatitis. Although some sources state that dairy cows may be treated with PG, its unclear if the resulting milk contains trace amounts of the compound. The allergy medicine companies didn't respond back when we emailed to ask the source of the ingredients. Immediateonset (minutes) severe systemic allergic reaction to an mRNA COVID19 vaccine. doi: 10.1016/j.anai.2022.05.014. PEG allergy was diagnosed as the cause of her Pfizer/BioNTech vaccine anaphylaxis. For example, if a processed food lists "flavorings", then PG may have been used as a component of that flavoring. Results: Her blood pressure improved but coughing persisted, with a drop in oxygen saturation to 85%. -, Su JR, Moro PL, Ng CS, Lewis PW, Said MA, Cano MV. You may switch to Article in classic view. 2022 Jan;149(1):168-175.e4. Propylene glycol is another trigger for systemic contact dermatitis, Nickel in foods can also be a trigger, especially for some patients with hand eczema. Please enable it to take advantage of the complete set of features! An official website of the United States government. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology. eCollection 2022. Be aware that medications can contain propylene glycol. (It's not found in nature, so we're only concerned with processed foods). She was treated in clinic with intramuscular adrenaline 0.5mg, intravenous chlorphenamine 10mg and hydrocortisone 200mg. Intradermal tests to PEG should be avoided because of the risk of inducing severe anaphylaxis. Seol JE, Ahn SW, Jang SH, Hong SM, Kim MY, Kim H. JAAD Case Rep. 2022 Aug 27. doi: 10.1016/j.jdcr.2022.08.029. After diagnostic evaluation, a safe COVID-19 vaccine could be offered to most patients, the remainders will await new vaccines containing different excipients. The .gov means its official. Skin prick testing was undertaken to PEG 400, 600, 2000, 3350, 4000, 6000, 8000 and 20,000 at 0.1% and 1% (w/v in Coca's solution) and polysorbate 80 at 10% and 20% (Thermo Fisher Scientific). Clin Exp Allergy. Systolic blood pressure dropped from 137mmHg to 107mmHg. Your doctor or pharmacist can be your greatest ally if they understand. Front Allergy. Int J Mol Sci. For others it may cause a skin rash, or trouble breathing, or gastrointestinal issues. This site is for people with allergies to glycol compounds, for health care practitioners, and for anyone wanting to know about life with an allergy to ubiquitous, invisible ingredients. Its in my shampoo! 2022 Jul;129(1):88-94.e1. Keywords: Allergic reactions to the coronavirus disease 2019 vaccine (ARCOV) study: The McGill University Health Centre experience. Basically, PG is not a bad chemical. 2015 Mar;45(3):669-76. doi: 10.1111/cea.12441. Its used because of its special properties, which include the ability to help active ingredients penetrate into the skin more effectively. , and therefore likely to injure public confidence. 8 Testing was positive to PEG 4000 at 1% of concentration (7mm wheal and 25mm flare). The case had a large positive skin prick test to PEG 4000 and systemic reaction on skin prick testing, confirming a reproducible response to PEG. 2022 Aug;77(8):2292-2312. doi: 10.1111/all.15241. University of Cambridge Clinical School, https://www.who.int/emergencies/diseases/novelcoronavirus2019/situatio Coronavirus disease (COVID2019) situation reports. It doesnt have any taste, scent, or color, which makes it easy to add to food products. Intradermal Testing With COVID-19 mRNA Vaccines Predicts Tolerance. Drug allergy; PEG allergy; Skin test to PEG and anaphylaxis. Again, the response seems to vary quite a bit from patient to patient. 2 doi: 10.1016/j.jaci.2021.05.020. This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. On the first day of the UK vaccination campaign with the coronavirus disease 2019 (COVID19) vaccine, there were reports of 2 cases of anaphylaxis within minutes of administration of the Pfizer/BioNTech messenger RNA (mRNA) vaccine and a third case of an allergic reaction not requiring adrenaline (epinephrine). Many of my patients who are allergic to PG in skin creams and medicated creams don't have any issues with PG in foods at all. How much PG would a patient need to consume before it triggers a rash? This handout has my short list of products that do not contain any propylene glycol (and also don't contain any of the common triggers of allergic skin reactions, such as synthetic and natural fragrance additives, formaldehyde preservatives, or methylisothiazolinone.). But some of these same patients can't handle certain foods. There has been a suggestion of crossreactivity between PEG and polysorbate 80 due to their similar chemical structures. Patients who are allergic to propylene glycol are not considered allergic to polyethylene glycol. Three were vaccinated before referral. PG is a synthetic liquid thats a little bit thicker than water. Thats why its approved for use in foods. What this means is that if you're highly sensitive to PG, you'll need to watch out for foods that list natural flavors, natural flavorings, artificial flavors, or artificial flavorings. Online ahead of print. Polyethylene glycols (PEGs) or macrogols are polyether compounds and are widely used as additives in pharmaceuticals, cosmetics, and food. We present 5 cases of confirmed PEG allergy, which to our knowledge is the largest case series to date. Bookshelf It's an emulsifier, which means it helps dissolve oil into water. Im not a medical professional just a person with a serious allergy to a set of commonly found and often invisible ingredients. Hours, or even days later, a rash begins on their skin. We thank the allergy nurses at Addenbrookes Hospital; Cambridge University Hospitals NHS Foundation Trust; Royal Papworth Hospital NHS Foundation Trust; Prof Nick Morrell, Department of Medicine; and Prof Duncan Jodrell for their support. Smith) had a perplexing food allergy. We suggest a guide to detecting PEG allergy based on our clinical experience and review of the literature in Table Table11. Unable to load your collection due to an error, Unable to load your delegates due to an error. Bruusgaard-Mouritsen MA, Jensen BM, Poulsen LK, Duus Johansen J, Garvey LH. The authors declare no conflict of interest. Why did her food allergy testing not pick up on this allergy? Published by Elsevier Inc. All rights reserved. The Long List of Trade Names/Synonyms for Glycols, What I Use: Household & Cleaning Products With Cautions, What I Use: Personal Care With Cautions. HHS Vulnerability Disclosure, Help These properties make both PG and ethylene glycol useful as preservatives and anti-freezing agents. Polyethylene glycol (PEG) is a synthetic polymer that is widely used in numerous products. 2022 Sep 30;3:1007602. doi: 10.3389/falgy.2022.1007602. 5 4 She gave a history of allergic reactions to multiple products including drug anaphylaxis. Because there are different types of food allergies, there are different types of food allergy tests. PEG Allergy & Colonoscopy Prep: Potential Risks, Article: Six Case Studies About Polyethylene Glycol Allergy, Links to COVID-19 Vaccine Ingredients Lists, Peer Reviewed Studies About Glycol Allergy. Methods: 2022 Jan;52(1):12-17. doi: 10.1111/cea.14064. Would you like email updates of new search results? Even more than that, it has several important properties that make it helpful for manufacturers when creating food products. If youre highly sensitive, you need to be aware of the exceptions. She had a persistent rash on her arms, and she noticed that it would worsen whenever she ate a particular brand of salad dressing. PEG is an excipient of many drugs, but hypersensitivity depends on its molecular weight (MW). It was even in one of her medicated steroid creams. This site is only for informational purposes and not to take the place of medical diagnosis or treatment. If you think back to my patient Mrs. Smith, she had negative food testing even though she was ultimately allergic to PG. Allergy to PEG is rare, Epub 2021 Feb 28. Allergy. Flavoring pastes used in baking often use propylene glycol. Polyethylene glycol as a cause of anaphylaxis. Because there are multiple types of food allergies and multiple types of food allergy tests. If youre not sure, we always start by focusing on skin care products and medicated skin creams first. Epub 2022 May 21. This preliminary report confirms PEG as a cause of anaphylaxis to the Pfizer/BioNTech vaccine, for the first time. 8600 Rockville Pike PEG is also called macrogol, Higher PEG MWs appear more allergenic, and molecular weight and amount of PEG determines whether an allergic reaction occurs. Other patients have told me that even a small amount of PG in their foods seems to aggravate their rash. Thats usually the last step, because its more involved and often isnt going to be necessary. Kelso JM, Greenhawt MJ, Li JT, et al. Its often used to help the mouthfeel of a food, for example to make it feel thicker and more substantial. Other mRNA COVID19 vaccines are in development. already built in. Skin testing for immediate hypersensitivity to corticosteroids: a case series and literature review. Although the Pfizer/BioNTech vaccine contains a number of excipients, PEG 2000 is the only one reported to cause anaphylaxis. This list of hypoallergenic skin care products has multiple options that patients can use. It is unclear if all cases of reported Pfizer/BioNTech vaccine anaphylaxis are due to PEG. This chemical was in several of her skin care products. Three were confirmed with positive skin prick test result to PEG, 1 confirmed with a positive intradermal test result, and 1 confirmed after positive oral challenge. To our knowledge, this is the first demonstration that anaphylaxis to the Pfizer/BioNTech vaccine can be due to PEG allergy. Mrs. Smith had developed a particular type of food allergy called. 8600 Rockville Pike and transmitted securely. Skin tests were undertaken to the index medications and to PEGs of different molecular weights. We also tested the Pfizer/BioNTech vaccine, excipients of the vaccine (1,2distearoylsnglycero3phosphocholine and cholesterol; SigmaAldrich Co), and the AstraZeneca COVID19 vaccine. 2012;130:2543. First, have you noticed that processed foods seem to make your rash worse? BruusgaardMouritsen MA, Johansen JD, Garvey LH. Propylene glycol is a small, synthetic alcohol (chemical formula CH3-CHOH-CH2OH) that has the potential to cause allergic contact dermatitis in some individuals. Here's one exception: if PG is used as a component of a flavoring, it may not be listed separately as an ingredient. I Want a COVID Vaccine That Wont Kill Me! Optimizing investigation of suspected allergy to polyethylene glycols. COVID19 vaccine anaphylaxis and PEG allergy are both rare, so proof of PEG as the cause in one case of vaccine anaphylaxis is important. https://www.nytimes.com/interactive/2020/science/coronavirusvaccinetracker, Multiple drug allergy to unrelated drugs with anaphylaxis or severe systemic reactions, Immediate onset, may include pruritus, erythema, urticaria, angioedema, rhinitis, wheeze, dyspnoea and hypotension, Common drugs containing PEG: laxatives, Gaviscon double action, depotcorticosteroids, for example methylprednisolone, Depo Provera, penicillin, Depends on brand (checklist of excipients 6.1 on SmPC or contents 6 on PIL).
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